CA-532-03 ASSOCIATION BETWEEN SLEEP APNEA, ATRIAL FIBRILLATION AND INCIDENT STROKE IN A VERY LARGE POPULATION OF YOUNG INDIVIDUALS

Abstract

Sleep apnea (SA) worsens outcomes in patients with atrial fibrillation/flutter (AF), and both are common in young patients (20-50 years). However, it is unreported what proportion of young patients with SA have or will develop AF or stroke. To define the relationships between AF, SA and stroke in a population >1MM, focused on the young (20-50 Y). We probed the Stanford Research Repository of electronic health data since 2008, for diagnoses of stroke, AF and SA using relevant codes (stroke: G45.X, G46.X, 434.X; AF: I48.X; SA: G47.X, 327.27). We identified 1660860 patients aged 20-50Y, of whom 29930 had SA, 4025 had AF, and 2985 had stroke (Fig A). AF was more common in patients with SA than without (odds ratio, OR: 16.6 [15.4-17.9, p<0.0001]). AF was diagnosed prior to SA in 90% of patients. However, patients with SA were more likely to develop AF than patients without SA (OR: 4.54 [3.97-5.02, p<0.0001]), and were more likely to have a stroke with AF than without AF (OR: 6.9 [5.3-8.9], p<0.0001). Among all patients in the population with AF, stroke was more common in patients with than without SA (OR 1.89 [1.32-2.71,p=0.004]) (Fig B). Notably, among all patients without AF, incident stroke was significantly more common in patients with SA than those without (OR 7.74 [6.90-8. 68 p<0.0001]), of which 67% of strokes occurred <1 year from the diagnosis of SA (Fig B) . Among these patients with SA and incident stroke, oral anticoagulation was more common in patients with a diagnosis of AF than without (60% vs 19%). We uncover a novel, strong association between sleep apnea, AF, and incident stroke in a population of >1.6 million young individuals. This may have implications for monitoring and anticoagulation therapy.